Confirmation Agreement
How to Accept Your Offer of Admission
To accept and finalize our offer of admission to Pacific University, please complete and return this form
along with the items listed below. In accordance with the Candidates' Reply Date Agreement of the
College Board, we ask that you notify Pacific University of your decision by May 1, 2017.
____1. Submit the $200 Non-refundable Enrollment Deposit.
When you enroll at Pacific, $100 of your deposit is applied toward your tuition. The remaining $100 is a general
deposit which is refundable after you graduate from Pacific. Pacific University accepts check, money order or credit
card. We accept Visa, Master Card, American Express or Discover. Include your card information on page
provided, or if you prefer, call the Admissions Office with the information at 1-800-677-6712.
___ 2. On Campus Housing
The Housing Department will begin to contact deposited new students on May 1st 2017, regarding the online
housing process. The University residency requirement is for all students under 20 years old prior to the beginning
of the fall term to live and board on-campus. Possible exemptions include: being married, having a dependent child,
or living with immediate family member within 20 miles of the University.
___3. I will not be attending Pacific University for the following reason___________________________
_____________________________________________________________________________________
Please sign and return this form with your $200 Deposit using the postage-paid envelope provided
and complete and submit your online Academic Interest Survey (available May 1, 2017).
By signing this document, you acknowledge and accept the conditions stated in this agreement.
____________________________________________________________________________________________
Signature
Date
____________________________________________________________________________________________
Legal Name (please print)
Social Security Number
Important Note: Pacific University must have official copies of transcripts from all High Schools and Colleges
you have attended. If you have not yet done so, please make arrangements to have your High School transcript(s)
sent to us as soon as your graduation date has been posted, and to have any College transcripts sent to us after grades
have posted. Failure to provide these documents may result in your not being allowed to register for a second
semester. If you have further questions, please contact the Office of Admissions at 1-800-677-6712 or locally at
503-352-2218.
Secure Payment Form
Office of Admissions
2043 College Way
Forest Grove, OR 97116
503-352-2218
Please Bill my Debit or Credit Card
We accept Visa, MasterCard, American Express, or Discover.
Student’s Name: ____________________________________________
Cardholder’s Name:__________________________________________
Credit Card#: _______________________________________________
Expiration Date ______/______
CVV code: ___________
Amount $200
Cardholder Phone:___________________________________________
Cardholder Signature: ________________________________________
Pacific University is committed to your financial security.
We ensure that this document, containing your financial information, will not be copied or reproduced.
Upon receiving this information, payment will be processed, immediately followed by secured shredding and disposal.